This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 30 April 2009

Attitudes towards Nursing. Part one: The American Media

It is sensible. It is not ignorant, inflammatory or insulting. It is a straightforward feature article on about nursing. It is American. The author did not use it as a jibe against nurses. The author did his research and spoke to real live nurses who are currently working in frontline care.

My favourite quotes are below. My own thoughts are in purple.

California's 2004 patient-nurse ratio law has helped with the workload in hospitals. But the sick have gotten sicker.

"Fifteen years ago, with a six- or seven-patient assignment, probably four of them could get up and about. A typical patient [today] has totally restricted movement, so we have to keep turning them as much as possible [to prevent] blood clots.

At the same time, this person can require IV medications every six hours and can be taking three different antibiotics every two to three hours and pain medicine every two hours. We are monitoring all of their lab results, making sure any tests that have been ordered have been followed through, and prepping patients for tests.That's just one patient -- and I can have up to five

It would be a good day if I had one patient who could get up and walk around and get to the bathroom and take care of washing up [on their own]. More often than not, I have at least three that require total care, meaning that everything has to be done for them.It's pretty hefty -- a day with four patients is OK, five is pushing it. It only takes one extra person to push you over the edge in terms of trying to manage your day".

Yes things are changing and moving faster. Patients are sicker and more complex. Here in the UK a nurse would be happy to have 6 patients. 6 Patients is the least I have ever had and it happened twice. My normal load can be anywhere between 6 and 35. And I have to perform just as well whether I have 6 patients or 35 patients...........................Anne

"As a new nurse in the 1980s, my patient load was probably three to four patients, which is what it is currently in pediatrics, but the patients were not as sick as they are now. There's been a definite change over time to a higher acuity [sicker] patient, requiring more technology, more paperwork, more intensive monitoring. If you had a patient assignment in the past, you might have one sick patient and several patients on the mend. But that has changed

I [used to] go home and be falling asleep and would wake myself up thinking, "Oh my God! Did I do such and such? Did I tell the next nurse about this or that?" Because you're so rushed you would be continually questioning, "Did I get everything done, was everybody safe?"

It's scary as hell. Come to England and have no control over how many patients you have and end up with 12 or 17 or 35 people to look after. People who probably need a one to one to get the kind of care they imagine that hospitals provide. See how that fucks with your serenity................Anne

"There are all kinds of complicated procedures and technology that the nurse is responsible for monitoring that didn't exist 10 years ago. A lot of patients are on continuous dialysis with machines. A lot of labs and drugs have to be given on an hourly basis. There are very critical IV drips, and you're titrating the drugs up and down based on the patients' clinical picture, and there is constant bedside decision-making with each patient.We also have [many more] patients who are on isolation precautions [because of infectious diseases] than we used to, which means gowning and gloving every time you walk into their room. That's very time-consuming, but very, very necessary. There is a much greater risk factor for people who work in healthcare now and it makes the care more complicated. There are a lot of things that have changed over the years that make the delivery of care a lot more complicated."

This is also the case in the UK, and these prehistoric long retired dinosaurs refuse to understand this fact. We now have more untrained staff now in proportion to trained staff. That means that there are very few people on the ward who can actually deal with this very complicated stuff. They are overwhelmed with it all. The patient loads that the RN's are forced to take on are horrendous. The nurses may have no control but they are still liable. The total care elderly patients are mixed in with acutely unwell medical patients. One acutely ill medical patient can keep a nurse on her toes for hours, constantly. But she still has 10 other total care elderly patients. Patients such as this really do need one to one care to have their dignity maintained and remain clean, hydrated etc. They do. They need that.

I walk away from a 90 year old dementia patient for 5 minutes to check on my bleeding patient and the 90 year old ends up covered head to toe in feces, and falls out of bed trying to help himself. Multiply this scenario by 10 and that is my normal patient load. This is the indignity of old age. Nurses did not create and can not cure old age. The families of these patients and the hospital managers do not want to lend a hand or pay for more of us. No one cares either...............................Anne

Reading a straightforward feature article about nursing is like taking in a breath of fresh air. The author of this article talked to nurses who have been nursing a long time,and are currently nursing.

8 comments:

When I was a baby doctor I remember patients going into hospital "for tests". They were basically well, mobile and self caring and pootled round the wards - even helping out if they could. They used to fill their time going to the hospital hairdresser so they would look good on the ward round! Now if you are even remotely well enough you are booted out, with everything done as an outpatient. The wards are full of dependant, sick patients with complex needs and multiple problems, acute and chronic, and none of this is taken into account in terms of staffing. Keep on spelling this stuff out to people Anne.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.